RU2387444C2 - Method of treating patients with chronic noncalculous cholecystitis and biliary dyskinesia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves application of low mineralised hydrocarbonate sodium mineral water "Abalahskaya" (AMW). Five procedures of AMW duodenal drainage are applied. AMW is introduced 3 times a day by daily intake within 18 days. In the first 2 days, AMW is taken is a dose 50-80 ml gradually increased to a single dose 200 ml. In hyposecretion, AMW is sipped 15-30 minutes before meals. In preserved secretion, AMW is introduced 40-45 minutes before meals in average swallowing. In hypersecretion, AMW is gulped 1-1.5 hours before meals. Hypomotor dyskinesia requires AMV at temperature 25-30°C, while hypermotor dyskinesia - at temperature 38-40°C. The immersion baths are carried out with 2% native AMW every second day. It is altered with electrophoresis with 2 % native AMW on the right hypochondrium every second day to 8-10 procedures in therapeutic course. The method improves clinical effectiveness ensured by using AMW with high concentration of hydrocarbonate ions that provides normalisation of acid-base balance, secretory and motor function of a stomach, gall bladder and bile passages, has an anti-inflammatory effect, improves bile structure.

EFFECT: immersion baths and electrophoretic AMW introduction improves its therapeutic action, increasing duration of exposure.

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Description

The invention relates to medicine, namely to gastroenterology and balneology, and for the prevention and treatment of diseases of the gallbladder (GI) and biliary tract (GI) with mineral water "Abalakhskaya", which in its characteristics relates to sodium bicarbonate with a total mineralization of 1.6 g / l, with a slightly alkaline reaction (pH-8.05).

Known natural low-mineralized waters with a high content of organic substances such as "Naftusya" of the Truskavets or Borjomi resort are widely used in the treatment of the genitourinary system and diseases of the stomach, liver, gall bladder and biliary tract (see the Guide to Sanatorium-Resort Selection. Edited by Bogolyubov V.M., M .: Medicine, 1986). With a good quality of treatment for diseases of the digestive system with these waters, their disadvantages include the fact that the best effect of the application is obtained by consuming water directly at the source, and when transported to distant regions and long-term storage, the effect is reduced, and such waters are considered as table or refreshing . Most resorts are located abroad, which leads to an increase in the cost of travel and treatment.

There is a treatment method that prescribes mineral water in combination with drug therapy 200 ml 45 minutes before meals three times a day (Belyaev A.G. Efficiency of using Svetlanovskaya mineral water in the treatment of patients with chronic cholecystitis: clinical, biochemical, functional and morphological aspects. / Abstract of thesis ... Candidate of Medical Sciences, Saratov, 2000, S.19-20). With this method, a combination of internal water intake with drug therapy is provided. The disadvantage of this method is that the treatment is carried out without first determining the type of impaired motility of the reduction of the arterial and intestinal tracts and the level of gastric secretion.

The closest analogue is a method for the treatment of slug syndrome in patients with chronic stoneless cholecystitis (Application No. 2003135835/14. A method for the treatment of slug syndrome in patients with chronic stoneless cholecystitis. / Authors: Sizykh TP, Kovaleva LP, Songolov V. I., publ. 2005, Bull. No. 26). With this method, a combination of internal water intake with tubing No. 3 and mineral water baths is provided. However, this method differs from the proposed method in that the internal use of mineral water is carried out without a period of adaptation to water, and also because electrophoresis is not carried out with mineral water.

With positive results in increasing the effectiveness of treatment due to the elimination of bile sediment, a weak targeted effect on the pathogenetic mechanisms of diseases of the organs of the biliary system should be attributed to the disadvantages.

The technical result of the proposed method of treatment is to increase the effectiveness of treatment due to external and internal use of Abalakhskaya mineral water (АМВ).

What is new in achieving the result is that low-saline hydrocarbonate sodium mineral water “Abalakhskaya” with a slightly alkaline reaction of the aqueous medium is used for the first time in medical practice, in particular in gastroenterology, and the treatment method is built taking into account the level of gastric secretion and the type of impaired motor activity of reducing the gastrointestinal tract and intestinal tract . The method includes daily drinking intake of AMB and duodenal drainage of AMB No. 5 in combination with electrophoresis of AMB to the right hypochondrium and baths of AMB in their native form every other day for 18-21 days, which meets the criteria of the invention (novelty).

A new set of features provides an increase in the effectiveness of treatment of diseases of the pancreas and gastrointestinal tract, prolonged remission, reduces the frequency of relapses and the risk of stone formation in the gastrointestinal tract that meets the criteria of the invention (industrial applicability).

Mineral water "Abalakhskaya" is universal in its action, due to the high content of bicarbonate ions (HCO3) and plays a large role in maintaining the acid-base (basic) balance, in normalizing the secretory and motor functions of the stomach, gastrointestinal tract and gastrointestinal tract and intestines, has a pronounced anti-inflammatory , choleretic and cholekinetic effect and improves the composition of bile.

Duodenal drainage with AMV during hypomotor dyskinesia enhances the motility of the gastrointestinal tract and gastrointestinal tract and elimination of bile, while hypermotor dyskinesia reduces spastic contractions and increases the volume of bile.

The introduction of AMB ions by electrophoresis deep into the tissue on the region of the right hypochondrium and the common bath enhances the therapeutic effect of the internal administration of AMB, and prolongs the period of its aftereffect.

The invention is aimed at expanding the range of medicinal mineral waters through the use of local mineral waters in the immediate vicinity of the source, the impact on the pathogenetic mechanisms of diseases of the stomach and gastrointestinal tract and increasing the effectiveness of treatment, as well as reducing treatment time.

The task is achieved by the proposed method.

The proposed method is carried out as follows: after the examination, a complex treatment is prescribed, including daily 3-time drinking consumption of AMV for 18 days, with a gradual increase in a single dose prescribed taking into account the level of gastric secretion and the type of impaired motility of the reduction of gastrointestinal tract and gastrointestinal tract, duodenal drainage 300 ml of AMB with a temperature of 36-37 ° C, 5 treatments per treatment course, common baths with AMB in their native form (2% solution) with a temperature of 36-37 ° C, lasting 10-12 minutes, alternating with electrophoresis of mineral water minutes in native form (2% solution) to the area of the right hypochondrium apparatus "Feed-1" amperage 15 mA for 15-20 minutes at 8-10 by treatment procedures.

The proposed method treated 38 patients with chronic non-calculous cholecystitis and biliary dyskinesia, of which 14 men and 24 women aged 27-59 years. The diagnosis is verified on the basis of complaints, medical history, examination data, clinical laboratory, instrumental and functional diagnostic research methods. The examination of patients was carried out in dynamics before and after a course of treatment. After conducting the course of treatment with the proposed method, a significant improvement in the general condition and well-being of patients was noted. In most patients, the severity of pain and dyspepsia was significantly reduced, and in some patients, dyspepsia was completely stopped. During the control examination after a course of treatment by the proposed method, a decrease in the inflammatory process in the mucous membrane of the stomach, 12 duodenal ulcer, intestinal tract and gastrointestinal tract and normalization of their motility were revealed. With ultrasound, a decrease in the longitudinal and transverse dimensions of the gallbladder, the disappearance of irregularities in the contours of the organ, the normalization of the size of the thickness and a decrease in the echo density of its wall, the normalization of motility of the biliary system are noted in the dynamics. When multifractional per minute duodenal sounding in the dynamics revealed the normalization of its indicators, confirming the positive impact of this method on the processes of bile formation and biliary excretion, on the colloidal stability of bile.

The proposed method is illustrated by the following clinical examples.

Example 1. Patient Ch., 48 years old, was treated at the Abalakh Republican Center for Rehabilitation and Restorative Medicine of the Ministry of Health of the Republic of Sakha (Yakutia) with a diagnosis of chronic non-calculous cholecystitis, a remission stage in combination with biliary dyskinesia of the hypomotor type. On admission, she complained of heaviness in the right hypochondrium after eating fatty, fried foods, severe flatulence, belching, heartburn, constipation.

From the anamnesis: sick for 15 years, exacerbation after errors in the diet. Examinations carried out prior to treatment revealed signs of chronic non-calculous cholecystitis, hypomotor biliary dyskinesia (according to multifractional per minute duodenal sounding and ultrasound examination of the posterior tract), endoscopically - mosaic gastric mucosa, moderate amount of secretory fluid, pyloric secretion, duodenal gastrointestinal function according to gastric sounding with limontar stimulation).

The treatment was carried out in accordance with the claimed method:

- daily drinking intake of AMB, water temperature 30 ° C, 45 minutes before meals in medium sips, at a usual rate of 50-80 ml 3 times a day for the first 2 days, from the 3rd to the 5th day, 100 ml 3 times a day, in the next 6-9 days, 150-180 ml 3 times a day, then 200 ml 3 times a day until the end of the course of treatment. The course of drinking treatment AMV 18 days;

- duodenal drainage with warm (36-37 ° С) mineral water "Abalakhskaya" (300 ml), No. 5;

- baths with mineral water in its native form (2% solution) every other day, 9 procedures;

- AMV electrophoresis in native form (2% solution) on the right hypochondrium in a day, 9 procedures.

The course of treatment is 18 days. After the treatment, the patient showed no complaints, the manifestations of pain, dyspeptic syndromes were completely stopped, the stool returned to normal. Clinical manifestations of balneoreaction were not observed. On a control endoscopic examination, reflux significantly decreased. During the control ultrasound examination of the gallbladder, a decrease in the size of the gallbladder and normalization of its motility were noted. According to multifractional per minute duodenal sounding, the tonus of the gastrointestinal tract and bile ducts returned to normal. In the IV phase, the voltage of the secretion of cystic bile increased from 1.6 ml to 2.3 ml per minute, with a norm of 1.9-2.3. With a microscopic examination of bile, after a course of treatment, a decrease in the content of Ca bilirubinate, cholesterol crystals in all portions of bile was noted.

The immediate result of treatment is a significant improvement.

Example 2. Patient P., 48 years old, was treated at the Abalakh Republican Center for Rehabilitation and Restorative Medicine of the Ministry of Health of the Republic of Sakha (Yakutia) with a diagnosis of chronic non-calculous cholecystitis in combination with biliary dyskinesia of the hypermotor type. He complained of severe, sometimes paroxysmal pain in the right hypochondrium, arising from physical and nervous stress and irregularities in the diet, constipation for 2-3 days, flatulence, heartburn, belching acid.

Examinations carried out prior to treatment revealed signs of chronic cholecystitis and hypermotor biliary dyskinesia (according to multifraction duodenal sounding and ultrasound examination of the gallbladder), endoscopically focal atrophic gastritis and duodenogastric reflux, and a low level of acid formation in the stomach (according to gastric probe )

The treatment was carried out in accordance with the claimed method:

- after the examination, the patient was prescribed drinking treatment of AMV, with a temperature of 38-40 ° C. A 3-time intake of AMV is recommended 25 minutes before meals in small sips, slowly 50-80 ml for the first two days, with a gradual increase in a single dose to 100 ml AMV for 3-5 days of treatment, 150-180 ml for 6 -9 days, 200 ml for 10-18 days of treatment;

- duodenal drainage warm (36-37 ° C) AMB (300 ml), No. 5;

- baths with mineral water in its native form (2% solution) every other day, 10 procedures;

- AMV electrophoresis in native form (2% solution) to the right hypochondrium in a day, 8 procedures.

The course of treatment is 18 days. The patient suffered well treatment, the clinical manifestations of balneoreaction were not identified. After the course of treatment, pain, dyspeptic syndromes were completely stopped, stool returned to normal. Significantly improved well-being of the patient. A follow-up examination showed a significant decrease in the frequency of bile reflux into the stomach, normalization of the tone of the sphincter of Oddi and the gall bladder, while in phase IV the voltage of cystic bile secretion decreased from 4.2 ml to 2.3 ml per minute, with a norm of 1.9-2 , 3. A control ultrasound revealed normalization of thickness and a decrease in the echo density of the gallbladder wall, as well as its motility. The immediate result of treatment is a significant improvement.

The studies and clinical trials showed the technical feasibility of the proposed method and allowed to justify the dose and methodology for the combined treatment of chronic non-calculous cholecystitis and biliary dyskinesia with the proposed Abalakhskaya mineral water and showed its effectiveness. The use of mineral water for the prevention and treatment of diseases of the digestive system expands the range of environmentally friendly, natural preparations, and promotes the introduction of local resources in medical practice.

Claims (1)

A method of treating patients with chronic non-calculous cholecystitis and biliary tract dyskinesia, including duodenal drainage and shared baths with low-mineralized mineral water and daily 3-fold intake of low-mineralized mineral water: with hypomotor dyskinesia - at a temperature of 25-30 ° C, with hypermotor dyskinesia - at a temperature 40 ° C, characterized in that as low-mineralized mineral water use low-saline hydrocarbonate sodium mineral water "Abalakh" (AMB), with this is followed by five duodenal drainage procedures, the intake of mineral water is carried out for 18 days, moreover, in the first 2 days, AMB is administered 50-80 ml with a gradual increase in a single dose to 200 ml, while AMB is administered with reduced secretion 15-30 minutes before meals in small sips, with preserved secretion - 40-45 minutes before eating in medium sips, with increased secretion - 1-1.5 hours before eating in large sips, shared baths are carried out with a 2% solution of native AMV every other day, and additionally carry out electrophoresis of a 2% solution of native AMV in the region p equal hypochondria every other day in alternation with baths for 8-10 procedures per course.